Would yoga be an effective complementary practice to the treatment of Complex – Post Traumatic Stress Disorder (C-PTSD)?

In this article the beneficial effects of yoga will be discussed in relation to some specific symptoms related to Complex-Post Traumatic Stress Disorder (C-PTSD). C-PTSD is a condition most often caused by repeated and ongoing, severe interpersonal trauma, it is commonly seen in those who were subjected to chronic childhood abuse. The symptoms of PTSD as stated in the NICE guidelines include, re-experiencing symptoms (e.g. flashbacks, nightmares, intrusive images, physical pain), avoidance of reminders of the traumatic event, hyperarousal (e.g. constantly on edge, hypervigilance of threat, insomnia) and emotional numbing. In addition C-PTSD sufferers can also experience, difficulty controlling emotions, inability to trust, feelings of permanent hopelessness/worthlessness/differentness, regular suicidal feelings, dissociative symptoms (e.g. feeling disconnected to the world around them, the body and ‘missing’ periods of time.) and risky or self-destructive behaviour. The main focus here will be reconnecting with the physical body, emotional recognition and regulation and looking at methods of grounding and staying connected to the present moment, by using yoga as a complimentary practice alongside regular treatment options.

adult alone anxious black and white

Photo by Kat Jayne on Pexels.com

As a mind and body practice, yoga has many benefits in beginning to connect to the physical body, and experience embodiment in a safe environment. By using techniques such as meditation and pranayama(breath control) the participant can be allowed time to sit,  focusing on something other than the trauma. Noticing the sensations within the body in relation to particular emotions, experiencing these as natural sensations, rather than something to be feared or avoided, using the compassionate stance of yoga to accept these emotions without negative judgements. Certain yoga positions such as a wide kneed child pose and breathing techniques such as full yogic breath or nadi shodhana (alternate nostril breathing) can stimulate the parasympathetic nervous system. There are several benefits to activating the parasympathetic nervous system during the process of recognising distressing sensations. The vagus nerve releases a hormone called acetylcholine which helps the body relax and reduces the stress hormones cortisol and adrenalin which are often over stimulated in sufferers.

At the time of the traumatic event, the body is flooded with adrenaline and stress hormones, which have been proved to interfere with effective memory processing and consolidation. So instead of the traumatic memory being filed away in linear time, it becomes timeless.’ –  Ryan,J. (yogabhoga.co.uk)

The vagus nerve can also help the sufferer process the trauma by stimulating the amygdala, the part of the brain which stores memory, this can allow the processing of trauma imprints to memory, allowing them to become rooted in time.

Work at the Trauma Center Yoga Program is based on the clinical premise that the experience of trauma affects the entire human organism—body, mind, and spirit—and that the whole organism must be engaged in the healing process.’ – Emerson,D. et.al (2009) p124

Many c-ptsd sufferers disconnect from the body because trauma is stored at a cellular level and is not fixed in time. If the sufferer comes into contact with a trigger they re-live the traumatic event as a full body experience, time shifts, physical sensations are experienced and sensory distortions occur. These symptoms are caused by an imprint on the cells similar in nature to the yogic concept of samskara. A samskara is a mental imprint, in full detail, left by all actions, thoughts and intentions, that is the root of many habitual behavioural patterns. It happens on a sub-conscious level, without active consideration.

candleinhandIn PTSD the trauma leaves a full imprint of the trauma which is not housed neatly in memory, it reacts to triggers on a subconscious level. By using yoga to look inwards the sufferer can begin to regain control of the experience. By beginning to see the trauma as separate to the true self, the process of embodiment and grounding to the present moment can begin to take place. By realising that they are not the trauma but a witness to it, a choice appears, either go with it and relive the trauma – effectively retraumatising or begin to recognise the bodily sensations and/or thought processes that lead up to the flashback or other reliving symptoms and nip it in the bud. By using mindful meditation, grounding techniques, breath work and movement. This gives the sufferer space to begin to work in a therapeutic setting.

Taking a trauma sensitive approach to teaching yoga is very important to prevent the sufferer becoming overwhelmed by experience. Emerson,D. et.al suggest 5 aspects of the traditional yoga class which need to be addressed; Environment, Exercise, Teacher qualities, Assists and Language. These are all important elements within any regular yoga class but are particularly important with trauma survivors.

  • The environment needs to be welcoming and safe, avoiding anything that may be a possible trigger to allow the participants to feel less vulnerable. Time should be taken with a gentle opening to let the participants settle into the space and begin to create a non-judgemental environment to begin exploring with movement and breath work.
  • The asana would depending upon the groups capabilities and stage of treatment, giving lots of options to explore how it feels in the body, or to opt out if overwhelmed. Focusing on allowing the participant the choice to do what they want with their body, empowering them to take charge of what happens to them.

No, I will not be in pain. My opinion about what is happening to me matters, and I can take control.” – Emerson,D. et al (2009)

o    Extra care needs to be taken with hip openers because positions e.g happy baby may be triggering. They will need to be gradually introduced step by step to allow the student to experience these positions in a state of safety

o   Savasana may also be problematic so approaching it more loosely and giving seated options as well as different lying positions.

  • The teacher needs to be welcoming, open, approachable and able to adapt on the spot if something unexpected happens. Allowing the students to explore and experience in their own way and at their own pace whilst holding a safe environment.
  • Assisting needs to be focused and efficient, physical adjustments may not be appropriate for many months if at all. Verbal cues can work much more effectively to give guidance whilst allowing for safe personal space. If approaching the participant this should be done clearly so they know where the teacher is at all times.
  • Language should be clear, avoiding possible trigger words. Encouragement and invitation in the instruction avoids the possibility of participants feeling coerced and lets them choose what to do or not do depending upon what they are experiencing.

In conclusion the inclusion of a trauma-sensitive yoga practice would be beneficial to complement the traditional talking therapies used to treat C-PTSD. Taking this approach would allow for a full body treatment and give the participants the tools needed to safely undertake the complex psychological work within the therapeutic setting.








Ryan,J. Yoga and PTSD retrieved from – www.yogabhoga.co.uk/yoga-articles/yoga-and-ptsd/






West, J., Liang, B., & Spinazzola, J. (2016, July 4). Trauma Sensitive Yoga as a Complementary Treatment for Posttraumatic Stress Disorder: A Qualitative Descriptive Analysis. International Journal of Stress Management. Advance online publication. http://dx.doi.org/10.1037/str0000040

Emerson,D., Sharma,R., Chaudhry,S. Turner,J. (2009) Yoga therapy in practice: Trauma-sensitive yoga: Principles, Practice & Research. International Journal of Yoga Therapy, no19, 123-128

What has breaking a rib taught me?

So 4 weeks ago today, a freak accident whilst adjusting a student left me with a broken rib. Now me being me, what do I do? “Oh its nothing… but ow its really sore… stop being a baby, suck it up and carry on!” I carried on teaching the class, ignoring my own pain and denying it was ‘that’ bad.

Next morning I wake up and my whole side is black with bruising, I am in severe pain but I just shrug it off, ignore my body telling me to stop and seek medical attention… for 2 weeks. I even attended a training weekend! Admittedly I did have to sit in the corner for most of the second day as I was feeling sick with pain.IMG_3034

It took some convincing to get me to actually check it out and when I did it was a reality check. I am not superwoman, I can’t just carry on regardless. This stubbornness to stop comes from my time dancing where admitting you were injured may jeopardise your position so you just get a load of steroid injections and continue. It is also the reason dancers (especially ballet dancers) end up broken by the time they retire at if your lucky 35ish. I am not condoning this behaviour and something needs to happen in the industry to give dancers more stability and support so they don’t feel pressured into doing this.

Anyway, sorry I got side tracked! The point is my mind went into this way of thinking automatically. Even though I spend every single day telling people to listen to their bodies and not to push themselves, to stop if there I any pain… And this is fine, in my regular practice I am mindful and aware of my body but for some reason when it comes to actual injury I know the theory but when push comes to shove I struggle to implement this for myself.

However anyone who has broken a rib knows that the pain is such that even breathing normally feels like your dying so carrying on ignoring it was not going to be sustainable and I was forced to stop my own practice completely and reduce my teaching schedule significantly.

and what happened?

Nothing, the world has not stopped spinning, no catastrophes have occurred…I am still here and haven’t had any kind of mental breakdown.

You see it was fear that was preventing me from looking after myself. Yoga is the only way I can keep myself relatively sane, it’s what got me from being a revolving door patient in mental health services as a shadow to living a full life and re-finding myself. IMG_0854(ok that sounds cheesy but its true so deal with it. It was my fear that taking away my physical practice and pranayama would send my back to the dark days. That everything would suddenly fall apart. I’m not saying yoga has made my life perfect by any means, every day is still a struggle, but the thought of moving backwards was worse than putting up with excruciating pain.

I learnt that I can just practice my meditation and the different mind set that comes with a yoga practice can carry me through. I can actually do this on my own, it is me doing it, the yoga is helping but its a tool… holding my hand rather than carrying me.

My next worry – how am I going to teach without moving?! How can I still pay my rent?… more on that tomorrow!